After some outside the box thinking.

[EveleenWinters]

Hi,
My mum is 28 stone, in a permanent wheelchair. She has multiple disabilities, her legs are bandaged & weigh a ton each.
She's 68 & has heart failure, kidney failure & on on oxygen.

She has her own mind.

She is refusing carers. Tried them for 6 weeks & it did not work for her. My brother lives with her.
The house is all adapted for her.
But the one massive area of struggle is she is severely urinary incontinent. She has a wonderful toilet that washes & drys her, but she is unable to to physically put a pad on.
She can only walk two steps. So transfer from chair to wheelchair, wheelchair to toilet, toilet to wheelchair.
She needs to rest in between as she can't breathe.
I'm physically usable to be there all the time.
So I need to come up with some way that she can put a pad on herself.
The pull pus don't go big enough or absorbant enough.
While she's prescribed pads, we buy extra long ones.
She should take 6 water tablets a day & hasn't taken them for over 6 weeks as she can't bare the thought of them.
It's all a complete mess & more going on than just this.
She can push the pad through her legs, but can't pull it up at the back.
She is physically unable to reach around to pull it up.
I'm incontinent myself, so am going to try rigging up something with a clip & string.
But If anyone has any suggestions a magical idea. I'd be grateful.
The ot also can't think of anything other than carers.
Many thanks

Tricky situation!

Can she put her hand behind her back at least partly/halfway?
Would it work for her to use some sort of shorter grip tool/grabber tool/reacher?

OK, I'm coming at this from a point of near ignorance, having never had to deal with anything like it at all - it sounds awful, embarrassing etc.

Could a wheelchair be adapted so it's more like a commode ie removable seat with a bowl underneath which is removable?

Other idea is to have a bag fitted, a urine bag with a catheter - I've no idea whether that's even feasible/practical?

Suprapubic catheter.

Can she pull her pants up?

I'm thinking set up a number of pairs of pants with a pad in so she just needs to pull the pants up.

It is! Thank you. Nope the grabbers don't work ro reach behind. She's lymphodema all over so also struggles to grip.
Honestly it's sad, she gave up when my dad died & is eating, what else has she got to look forward to! She's not been out of the house since he died as dwp took the mobility van back as it was dad's. She can't fit in anything else. It's horrible.

I've just ordered full knickers as she uses the pad specific ones which are so elasticised so they constrict the pad. Thank you, wish us luck.

They won't give her a catheter. It would be the simplest option.

Thank you, they won't do it

Unfortunately I would imagine the risk of infection if she can’t keep herself clean rules out a Catheter bag.

If she can’t reach round the back could she use a long handled tool to push the pad back from the front?

It must be so difficult for you and your brother, is she open to some kind of therapy?

What does she wear on her bottom half?
Can she give up on pants, wear big flowy shirts, lifted up so she's not sitting on them and just sit on a seat pad to a absorb leaks?

The palliative care nurses recommended Boots own brand incontinence pants for my husband, they were soft and comfortable, very absorbent and easy to pull off and on. I'm sure they have a female equivalent.

I'm in a very similar situation to what you are describing. The first thing to do is to get them to prescribe her the more absorbent Tena comfort super or comfort maxi because they are a longer length. Then depending on the size she needs some Tena Fix in 3XL or buy some AbriFix fixation pants likely in size 4XL. From what you are describing and the weight, I think she is wearing the wrong size of fixation pants. If they are too tight to be squashing the pads, they will be difficult to fit/change and stop the pads from absorbing. They need to fit enough to be supportive but not squished. AbriFix pants have a much larger size and go up to size 6xl. You'll have to buy them as the NHS doesn't supply AbriFix but age UK and the incontinence websites do.

To change the pads, put on the fixation pants first so you can get them to hold up the pad as you place it. Pull the fixation pants down, so they are right at the top of her thighs, leaving a little slot to post the pad through. Get the Tena pad and fold it in half lengthwise and slot it between the legs as far backwards as possible but keep it folded lengthwise still, as this helps with getting the back part fitted in the next step.
Now pull up the fixation pants into place around her waist. The pad will be pushed against her skin, but as it gets up nearer the waist you can put your hand down the back waistband Fitting guidebetween the fixation pants and pad. Open it flat against her skin and smooth it out flat behind. Pulling the outside edges as wide as possible. Put your hand down the waistband between the front of the fixation pants and the pad. Then gently tug the sides of the front piece of the pad to fit in the creases between her legs and pelvis, leaving the extra bulk of pads still slightly folded down. As long as the sides are sealed against her skin, it shouldn't leak until overfilled.

It's also possible to just pull the back of the fixation pants and pad down the bum enough to get it out of the way to wee and then pull it back up again using the fixation pants.

I have a fused spine and in a wheelchair with only a maximum of 30 seconds of weigh bearing, so I understand the struggles she's facing. I felt like all my independence was taken away when I first got changed to Comfort pads and found the system I've described to work the best when there's no carer to help.

I've tried to attach the YouTube fitting guide that shows what I mean by using the fixation pants to hold the pads. I hope you will be able to teach your mum to do this for herself.

I couldn't get it to link but either search Tena comfort fitting guide on YouTube or copy the text below

https://m.youtube.com/watch?v=9MISyznjOso&t=151s&pp=ygUVVGVuYSBjb21mb3J0IGZpdHRpbmcg

How are you getting in @EveleenWinters?